APPROCH TO A PATIENT WITH INFECTIOUS MONONUCLEOSIS IN FAMILY MEDICINE

Infektivna mononukleoza (IM) je akutna zarazna bolest samoograničavajućeg tijeka, koja se prezentira trijasom simptoma: vrućicom, faringitisom i limfadenopatijom. U 90% slučajeva uzrokovana je EBV virusom, a u ostalih 10% radi se o “sindromu nalik na IM” kojeg uzrokuju brojni drugi uzročnici poput CMV-a, BHS-A, Toxsoplasme gondii, HIV-a, adenovirusi te HHV 6 i 7. Budući da se najčešće prenosi slinom i ima najveću incidenciju u adolescentnoj dobi naziva se “bolest poljupca”. Hoće li se razviti klinička slika IM ovisi o dobi kada je došlo do primoinfekcije. U djece primoinfekcija obično prolazi subklinički, u adolescenata razvoj kliničke slike IM moguć je u 30-70% slučajeva. Uz tipičnu kliničku sliku mogu se javiti periorbitalni edemi, splenomegalija, palatalne petehije, hepatomegalija, osip i rijetko žutica. Dijagnoza se postavlja temeljem kliničke slike, fizikalnog pregleda, razmaza periferne krvi, hepatograma, seroloških i ostalih pretraga. Najznačajniji dijagnostički znakovi su limfocitoza u DKS, više od 10% atipičnih limfocita u razmazu periferne krvi i pozitivni serološki testovi na heterofilna ili specifična EBV protutijela. Radi široke diferencijalne dijagnoze EBV IM, poželjno je dijagnostičke korake provoditi pomoću algoritma i tako osigurati dijagnozu bolesti. Komplikacije su rijetke, mogu biti akutne (rane) i kronične (kasne). Najčešće akutne komplikacije su reaktivni hepatitis, hematološke komplikacije, akutna opstrukcija gornjeg dišnog puta i ruptura slezene. Kao kronične komplikacije mogu se javiti CAEBV, CFS, maligne i autoimune bolesti. Liječenje se temelji isključivo na suportivnim mjerama, budući se antivirusni lijekovi nisu pokazali učinkovitima.Infectious mononucleosis (IM) is an acute infectious disease of self-limiting course, presented by a triage of symptoms: fever, tonsillar pharyngitis, and lymphadenopathy. In 90% of cases, it is caused by the EBV virus and other 10% is presented as "IM-like syndrome" which is caused by many other pathogens such as CMV, BHS-A, Toxsoplasma gondii, HIV and adenoviruses. Because it is most commonly transmitted by saliva and has the highest incidence in adolescence, it is also called "kiss disease". In children, primoinfection usually goes subclinically, while in adolescents the development of a clinical picture of IM is possible in 30-70% of cases. With typical clinical picture can occur: periorbital edema, splenomegaly, palatal petechiae, hepatomegaly, rash and rarely jaundice. The diagnosis is made on the basis of clinical imaging, physical examination, CCS, smear of peripheral blood, hepatograms, serological and other examinations. The most significant diagnostic signs are lymphocytosis in DKS, more than 10% of atypical lymphocytes in peripheral blood smear and positive serological tests for heterophilic or specific EBV antibodies. Due to the wide differential diagnosis of EBV IM, it is advisable to perform diagnostic steps using algorithms to ensure accurate diagnosis of the disease. The most common acute complications are reactive hepatitis, hematologic complications, acute upper airway obstruction and splenic rupture, but they can manifest in the form of any organ system. CAEBV, CFS, malignant and autoimmune diseases can be chronic complications. Treatment is based on supportive measures, since antiviral drugs have not proven effective